新辅助化疗局部晚期宫颈癌前后Ki-67、P-gp表达水平及临床意义

Difference of Ki-67 and P-gp expression level before and after neoadjuvant chemotherapy for locally advanced cervical cancer and its clinical significance

目的：探究Ki-67核抗原（Ki-67）、P－糖蛋白（P-gp）在宫颈癌新辅助化疗前后的的变化，分析其与化疗疗效及敏感性之间的相关性，为新辅助化疗的敏感性指标的确定提供理论基础。方法随机挑选来永康市妇幼保健院行宫颈癌新辅助化疗的Ⅰb2～Ⅱb期宫颈癌患者50例，采用免疫组化的方法检测化疗前后宫颈组织中Ki-67、P-gp的表达，计算并分析其表达变化及与化疗效果和敏感性之间的相关性。结果宫颈癌新辅助化疗的总体有效率为86％，稳定的有7例，无患者表现为进展；Ki-67化疗前的阳性表达率为90．00％，显著高于化疗后的65．00％，差异具有统计学意义（χ2＝23．67，P＜0．05），P-gp化疗前阳性表达率为56．00％，化疗后为85．00％，差异具有统计学意义（χ2＝21．98，P＜0．05）；化疗前Ki-67阳性的患者化疗有效率为91．11％，显著高于Ki-67阴性的化疗有效率（χ2＝9．67，P＜0．05），而化疗前P-gp阳性的患者化疗有效率为39．29％，P-gp阴性的有效率100．00％，差异也具有统计学意义（χ2＝10．85，P＜0．05）。 Ki-67和P-gp的炎性表达呈现负相关关系（ r＝0．5872，P＜0．05）。结论宫颈癌新辅助化疗后与化疗前相比Ki-67阳性表达率降低，P-gp阳性表达率升高，可为临床治疗提供依据。

Objective To explore the changes of Ki-67 nuclear antigens （Ki-67） and P-glycoprotein （P-gp） before and after cervical cancer neoadjuvant chemotherapy and analyze their correlation with efficacy and sensitivity of chemotherapy , so as to provide theoretical basis for determination of sensitivity indicators of new adjuvant chemotherapy .Methods Fifty cases of cervical cancer in Ⅰb2~Ⅱb stage treated with neoadjuvant chemotherapy in Maternal and Child Health Care Hospital of Yongkang City were randomly selected .Expression levels of Ki-67 and P-gp in cervical tissue were determined by immunohistochemical method before and after chemotherapy .Correlation of the changes of expression with chemotherapy efficacy and sensitivity was calculated and analyzed .Results Overall effective rate of cervical cancer neoadjuvant chemotherapy was 86%, and 7 cases were stable .No patients showed progression .Positive expression rate of Ki-67 before chemotherapy was 90.00%, which was higher than that after chemotherapy （65.00%） with statistical significance （χ2 =23.67, P〈0.05）.Positive expression rate of P-gp before chemotherapy was 56.00%, which was 85.00% after chemotherapy.Difference had statistical significance （χ2 =21.98, P 〈0.05 ）.Chemotherapy effective rate of Ki-67 positive patients was 91.11%, which was significantly higher than that of Ki-67 negative patients （χ2 =9.67, P〈0.05）.Chemotherapy effective rate of P-gp positive patients was 39.29%, and that of P-gp negative patients was 100.00%.The difference was statistically significant （χ2 =10.85, P 〈0.05）. Inflammatory expression of Ki-67 and P-gp presented negative correlation （r=0.5872, P〈0.05）.Conclusion Positive expression rate of Ki-67 decreases after neoadjuvant chemotherapy for cervical cancer , while positive expression rate of P-gp increases , which can provide basis for clinical treatment .